The creation of the Beijing Suicide Research and Prevention Center is the culmination of seven years of effort by the Beijing Hui Long Guan Hospital. With the strong support of the Beijing Government and the Beijing Bureau of Health, we are using the findings from our extensive research about suicide and attempted suicide to develop a unique set of services and preventive programs and will provide technical assistance to institutions that are interested in developing similar centers in different parts of the country.
The Research Center of Clinical Epidemiology at the Beijing Hui Long Guan Hospital has conducted several large collaborative projects on suicide since 1995. We have done detailed analyses of the rates and patterns of suicides in China based on data from the two national mortality registries—the Ministry of Health’s system and the Disease Surveillance Points system. In collaboration with the Chinese Centers for Disease Control and Prevention (formerly the Chinese Academy of Preventive Medicine) we conducted a 23-site national ‘psychological autopsy’ study of completed suicide that is the largest such project every completed anywhere in the world. We conducted two multi-site case-control studies with over 650 attempted suicides and have done a 2-year follow-up on 380 of the cases . An on-going study with 30 general hospitals around the country has already collected retrospective data on the emergency room visits of over 10,000 suicide attempters and prospective data on about 3,000 suicide attempters. As the first step to developing a China-specific questionnaire on public attitudes about suicide, we have completed 120 focus groups with a wide range of informants from four locations in the country. We are responsible for the China component of the multi-national WHO Supre-Miss project on suicide prevention. And we are conducting a number of national and international projects on depression, the mental illness most closely associated with suicide.
These studies have proven that suicide seriously undermines the health and, ultimately, the productivity of the country. Our work and that of other researchers has, over the last few years, lead to a gradual recognition of the public health importance of suicide for China. In a high-level awareness-raising meeting between the WHO and the Ministry of Health in Beijing in November 1999, the Vice-minister of Health identified suicide as one of the most important mental health problems for the country. Then at the 3rd National Working Meeting on Mental Health in Beijing in November 2001, the Vice-minister reported that there are at least 250,000 suicides deaths and 2 million suicide attempts a year. Our own analysis of national mortality data for 1995-1999 indicates that suicide is the 5th most important cause of death in the country and the leading cause of death among young adults 15 to 34 years of age. Moreover, each completed or attempted suicide has a profound effect on family members and close associates of the victim that often persists through the remainder of their lives. Thus the combined economic and social impact of suicide on the country is tremendous.
Non-suicidal psychological crises are even more common. According to the 1996 “Global Burden of Disease” report of the World Bank, 95% of the 16.2 million persons in China with serious depression, 6.6 million persons with panic disorder and 3.2 million persons with post-traumatic stress disorder never receive treatment. Increasing numbers of reports in the public press about the psychological problems related to natural and man-made disasters (e.g., floods, mine accidents), alcohol and drug use, population migration, divorce, family violence, single-child families, school pressure, unemployment, and competition indicate that the public is gradually becoming aware of the importance of psychological health to the overall quality of life. These problems are likely to increase over time as the effects of entry into the WTO and other major social and economic reforms spread across the country. This could lead to an increase in the rates of suicide in coming years.
A collaborative meeting between the Ministry of Health and the WHO on suicide prevention (coordinated by our hospital) held in Beijing in March 2000 concluded that very little is being done about these important public health problems. Many countries have comprehensive national suicide prevention plans, but China’s work in this area is just starting. Our collaborative research with the Chinese Centers for Disease Control and Prevention found that:
· about 70% of persons who die or attempt suicide never received any form of help for their problems,
· 60% of persons who die of suicide and 40% who attempt suicide have a serious mental illness at the time, and
· less then 1% of the 2 million persons who are treated for suicide attempts in the emergency rooms of general hospitals around the country every year receive psychiatric evaluation or treatment at the time of their emergency room visit.
The current mental health system is ill-equipped to address this public health emergency. Focused on the inpatient treatment of persons with severe psychoses, psychiatric hospitals—where over 90% of the mental health professionals in the country work— do not have sufficient staff who are trained to provide the range of services needed to treat and prevent suicides. Effective prevention and management of suicides requires the development of a new class of community-based services. These new service centers could be free-standing institutions or situated in mental health or public health institutes, but their staff members will need a range of skills that goes far beyond the direct provision of mental health care and so they should include individuals with training in public health and social work as well as those with training in mental health. These suicide research and prevention centers need to fulfill a variety of functions:
· effectively coordinate the wide range of organizations and institutions that are essential to the comprehensive prevention and management of suicide: mental health services, general hospitals, public health institutions, telephone hotlines, schools, the women’s federation, youth groups, senior citizen’s groups, media organizations, police, the agricultural bureau (for the control of pesticides used in suicides), and others;
· become effective advocates of the importance of mental health issues, so that the leadership and staff of these organizations are willing to actively participate in preventive activities;
· conduct ongoing training programs about the recognition and management of suicidal risk for staff members in different types of service organizations;
· monitor the pattern of completed and attempted suicides in the general population;
· coordinate research on the causes and prevention of suicide; and
· employ the media and other methods to gain public support for the suicide prevention effort, to improve psychological awareness in the general population, and to increase the willingness of those with psychological problems to seek help before it is too late.
The eventual goal is the development of a network of government-supported suicide research and prevention centers and a national suicide prevention organization that systematically monitors the pattern of completed and attempted suicides around the country, that supports the development of prevention and treatment services and that coordinates national research on the causes and prevention of suicide. As the capitol of the country, it is appropriate for Beijing to take the first steps towards this long-term goal; the model for this new type of suicide research and prevention center developed in Beijing can subsequently be adapted for use in other locations around the country. With this long-term goal in mind, the Beijing Bureau of Health and the Beijing City Government formally approved the founding of the “Beijing Suicide Research and Prevention Center” at Beijing Hui Long Hospital in November 2001 and provided funding to establish the Center in April 2002. Since that time we have been busy recruiting and training staff, developing facilities and services, establishing collaborative relationships with other institutions and seeking additional funds to support our multiple research and service activities. We plan to start providing services over the next few months and to be fully operational by 1 March 2003.